New Directions in Psychotherapy

In their book, The Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy Work, Wampold and Imel conclude that psychotherapy is remarkably effective: “The effects of psychotherapy are greater than the effects of many medical practices, including flu vaccines, most interventions in cardiology, and treatments for asthma, some of which are very expensive and have significant side effects. Psychotherapy is as effective as medication for most mental disorders, without the side effects. As well, psychotherapy is longer lasting than medications . . . “

In the history of psychotherapy including Psychoanalysis, Behaviorism, and Humanism, Cognitive Behavioral Therapy (CBT) has emerged as the most effective approach to helping people achieve the change in their lives they desire.

But while Cognitive Behavioral Therapy has been shown to be particularly effective, it tends to cast symptoms as the problems. CBT treatments are almost always designed to help clients control and master symptoms associated with anxiety, depression, or other concerns.

A newer generation of therapies aim beyond merely learning to control anxiety. In fact, they focus instead on accepting a degree of anxiety while working to achieve goals and live a meaningful life.

Among these variations of CBT, two particularly effective therapies are Dialectical Behavior Therapy (DBT) and Acceptance and Commitment Therapy (ACT). Both draw heavily on Mindfulness, an eastern practice with its origins in Buddhism which was westernized especially by Jon Kabat-Zinn in the 1970’s.

Mindfulness has become one of the most helpful therapeutic techniques in the practice of psychotherapy today. With mindfulness, the focus is simply on being aware of thoughts and feelings without judging them or over identifying with them. Thoughts are regarded as mental events which may or may not reflect what we really believe or know to be true.

With mindfulness, individuals learn to be fully aware of their experience in the present moment without dwelling on the past or worrying about the future. Individuals also learn to replace automatic reactions with more carefully considered attitudes and behaviors, to make peace with the losses and disappointments in life, and to accept the limitations in life without fretting over every injustice or having to eliminate every deficiency. Healthy living in all respects is also encouraged.

Drawing on strategies associated with Mindfulness as well as with Exposure Therapy, DBT and ACT have shifted the focus from an effort to eliminate symptoms to tolerating distress while pursuing one’s goals in life.

For example, consider anxiety. The problem with anxiety is that the more one struggles to eliminate it, the more anxious one often tends to become! The struggle with anxiety can inadvertently help to keep it centerstage.

The biggest problem with anxiety is when we become fearful of it. An anxiety disorder causes us to be fearful when there is nothing really to be fearful of. But when we avoid or escape from situations that cause anxiety and then attribute our comfort to the avoidance behavior rather than to the fact there was no danger, we only reinforce our fear.

In Exposure Therapy, anxiety is extinguished by not reinforcing it through escape or avoidance.
Studies have consistently shown Exposure Therapy to be highly effective in treating all anxiety disorders.

With Exposure Therapy as utilized in DBT and ACT, the processes that turn normal anxiety into major problems are targeted while any lingering anxiety is addressed in a manner so as not to impede one’s goals and values.

For example, author Barry McDonagh suggests that individuals give up the idea of trying to be calm and instead expose themselves to anxiety by simply allowing it. He encourages folks to dismiss the build-up of those initial “What if’s?” by answering “So what!” In this way, anxiety is defused by outrightly dismissing the fear of it.

After dismissing the fear of anxiety, McDonagh describes mindful ways individuals can be aware of any remaining anxiety while yet occupying themselves with activities that really engage their minds and enable them to achieve their goals.

There is a saying that “What we resist, persists.” There is a difference between resisting fear and dismissing it. When we dismiss a fearful thought, there is no struggle, only a clear and decisive act of agency. And when we allow ourselves to be aware of an anxious thought without focusing on it, we protect the opportunity to lead the life we want to live.

ACT, in particular, acknowledges that there can be hurt and heartache in our lives, yet it offers that such pain or suffering need not deter us from focusing on our goals.